Early language processing efficiency and pre-literacy outcomes in children born full term and preterm.

Language processing efficiency-that is, the skill at processing language in real time-assessed in toddlerhood is associated with later language outcomes in children born full term (FT) and preterm (PT) during school age. No studies to date have assessed patterns of relations between early language processing efficiency and pre-literacy skills, such as print knowledge and phonological awareness, and whether relations are similar in FT and PT children. In this study, participants (N = 94, 49 FT and 45PT) were assessed in the looking-while-listening (LWL) task at 18 months of age (corrected for degree of prematurity), deriving measures of processing speed and accuracy. At 4½ years of age, children were assessed on standardized tests of print knowledge, phonological awareness, and expressive language. Processing speed and accuracy predicted both pre-literacy outcomes (r2 change = 7.8%-19.5%, p < .01); birth group did not moderate these effects. Relations were significantly reduced when controlling for expressive language. Thus, early language processing efficiency supports later expressive language abilities, which in turn supports developing pre-literacy skills. Processing speed and phonological awareness were also directly related, indicating an independent role for processing speed in literacy development. Mediation effects were not moderated by birth group, suggesting a similar developmental pathway in FT and PT children.

Associations between early efficiency in language processing and language and cognitive outcomes in children born full term and preterm: similarities and differences.

Associations between children's early language processing efficiency and later verbal and non-verbal outcomes shed light on the extent to which early information processing skills support later learning across different domains of function. Examining whether the strengths of associations are similar in typically developing and at-risk populations provides an additional lens into the varying routes to learning that children may take across development. In this follow-up study, children born full-term (FT, n = 49) and preterm (PT, n = 45, ≤32 weeks gestational age, birth weight <1800 g) were assessed in the Looking While Listening (LWL) task at 18 months (corrected for degree of prematurity in PT group). This eye-tracking task assesses efficiency of real-time spoken language comprehension as accuracy and speed (RT) of processing. At 4 ½ years, children were assessed on standardized tests of receptive vocabulary, expressive language, and non-verbal IQ. Language processing efficiency was associated with both language outcomes (r2-change: 7.0-19.7%, p < 0.01), after covariates. Birth group did not moderate these effects, suggesting similar mechanisms of learning in these domains for PT and FT children. However, birth group moderated the association between speed and non-verbal IQ (r2-change: 4.5%, p < 0.05), such that an association was found in the PT but not the FT group. This finding suggests that information processing skills reflected in efficiency of real-time language processing may be recruited to support learning in a broader range of verbal and non-verbal domains in the PT compared to the FT group.

N-Terminal Pro-B-Type Natriuretic Peptide as a Biomarker for the Severity and Outcomes With COVID-19 in a Nationwide Hospitalized Cohort.

Background Currently, there is limited research on the prognostic value of NT-proBNP (N-terminal pro-B-type natriuretic peptide) as a biomarker in COVID-19. We proposed the a priori hypothesis that an elevated NT-proBNP concentration at admission is associated with increased in-hospital mortality. Methods and Results In this prospective, observational cohort study of the American Heart Association's COVID-19 Cardiovascular Disease Registry, 4675 patients hospitalized with COVID-19 were divided into normal and elevated NT-proBNP cohorts by standard age-adjusted heart failure thresholds, as well as separated by quintiles. Patients with elevated NT-proBNP (n=1344; 28.7%) were older, with more cardiovascular risk factors, and had a significantly higher rate of in-hospital mortality (37% versus 16%; P<0.001) and shorter median time to death (7 versus 9 days; P<0.001) than those with normal values. Analysis by quintile of NT-proBNP revealed a steep graded relationship with mortality (7.1%-40.2%; P<0.001). NT-proBNP was also associated with major adverse cardiac events, intensive care unit admission, intubation, shock, and cardiac arrest (P<0.001 for each). In subgroup analyses, NT-proBNP, but not prior heart failure, was associated with increased risk of in-hospital mortality. Adjusting for cardiovascular risk factors with presenting vital signs, an elevated NT-proBNP was associated with 2-fold higher adjusted odds of death (adjusted odds ratio [OR], 2.23; 95% CI, 1.80-2.76), and the log-transformed NT-proBNP with other biomarkers projected a 21% increased risk of death for each 2-fold increase (adjusted OR, 1.21; 95% CI, 1.08-1.34). Conclusions Elevated NT-proBNP levels on admission for COVID-19 are associated with an increased risk of in-hospital mortality and other complications in patients with and without heart failure.

Predictors of early vocabulary growth in children born preterm and full term: A study of processing speed and medical complications.

Delays in expressive vocabulary may be harbingers of long-term language difficulties. In toddlers born full term (FT), individual differences in language processing speed are associated with variation in expressive vocabulary growth. Children born preterm (PT) are at increased risk for persistent language deficits. Here, we evaluate predictors of early vocabulary growth in PT toddlers in relation to two sources of variability: language processing speed and medical complications of prematurity. Vocabulary growth from 16 to 30 months (adjusted for degree of prematurity) was modeled longitudinally using parent reports in English-speaking FT (n = 63; ≥37 weeks, ≥2495 g) and PT (n = 69; ≤32 weeks, <1800 g) children, matched on sex and socioeconomic status. Children were tested in the "looking-while-listening task" at 18 months to derive a measure of language processing speed. Each PT child was assessed for number of medical complications (13 maximum), based on medical chart reviews. PT and FT children displayed similar vocabulary trajectories; however, birth group disparities began to emerge by 30 months. PT children were slower in language processing speed than FT children. Critically, language processing speed predicted expressive vocabulary size at 30 months; interactions with birth group were not significant (all p > .20). In PT children, faster language processing speed predicted stronger outcomes regardless of number of medical complications; slower processing speed and more medical complications predicted poorer outcomes. Faster processing speed reflected favorable neuropsychological processes associated with faster expressive vocabulary growth that overrode the impact of medical complications on language outcomes in PT children.

Caregiver Talk and Medical Risk as Predictors of Language Outcomes in Full Term and Preterm Toddlers.

This study examined associations between caregiver talk and language skills in full term (FT) and preterm (PT) children (n = 97). All-day recordings of caregiver-child interactions revealed striking similarities in amount of caregiver talk heard by FT and PT children. Children who heard more caregiver talk at 16 months demonstrated better knowledge- and processing-based language skills at 18 months. The unique contributions of caregiver talk were tempered by medical risk in PT children, especially for processing speed. However, there was no evidence that birth status or medical risk moderated the effects of caregiver talk. These findings highlight the role of caregiver talk in shaping language outcomes in FT and PT children and offer insights into links between neurodevelopmental risk and caregiver-child engagement.

Quality of caregiver-child play interactions with toddlers born preterm and full term: Antecedents and language outcome.

BACKGROUND: Preterm birth may leave long-term effects on the interactions between caregivers and children. Language skills are sensitive to the quality of caregiver-child interactions. AIMS: Compare the quality of caregiver-child play interactions in toddlers born preterm (PT) and full term (FT) at age 22months (corrected for degree of prematurity) and evaluate the degree of association between caregiver-child interactions, antecedent demographic and language factors, and subsequent language skill. STUDY DESIGN: A longitudinal descriptive cohort study. SUBJECTS: 39 PT and 39 FT toddlers individually matched on sex and socioeconomic status (SES). OUTCOME MEASURES: The outcome measures were dimensions of caregiver-child interactions, rated from a videotaped play session at age 22months in relation to receptive language assessments at ages 18 and 36months. RESULTS: Caregiver intrusiveness was greater in the PT than FT group. A composite score of child interactional behaviors was associated with a composite score of caregiver interactional behaviors. The caregiver composite measure was associated with later receptive vocabulary at 36months. PT-FT group membership did not moderate the association between caregiver interactional behavior and later receptive vocabulary. CONCLUSIONS: The quality of caregiver interactional behavior had similar associations with concurrent child interactional behavior and subsequent language outcome in the PT and FT groups. Greater caregiver sensitivity/responsiveness, verbal elaboration, and less intrusiveness support receptive language development in typically developing toddlers and toddlers at risk for language difficulty.